Pescatori Lorenzo, Tropeano Maria Pia, Ciappetta Pasqualino
Department of Neurosurgery, Ca' Foncello Hospital, Treviso, Italy; Department of Neurosurgery, University Sapienza of Rome, Rome, Italy.
Department of Neurosurgery, University Sapienza of Rome, Rome, Italy.
World Neurosurg. 2018 Oct;118:e489-e499. doi: 10.1016/j.wneu.2018.06.222. Epub 2018 Jul 6.
The Meckel's cave (MC) is commonly affected by neoplastic lesions that often require neurosurgical treatment. We simulated the posterior petrous apicectomy (PPA) on fresh cadavers to verify the in vivo feasibility of the approach. We proposed a new classification system of MC meningioma based on the extent of middle cranial fossa (MCF) involvement.
Ten fresh, non-formalin-fixed specimens were used in this study. Through a retrosigmoid approach, 20 PPAs were performed. Subsequently, the cerebral hemispheres were removed to quantify the MCF exposure and dimensions of the suprameatal tubercle. Twenty-four patients operated on for MC meningioma were classified as follows: group 1, tumor <3 cm; group 2, tumor >3 cm. Group 2 was subdivided into to 5 subtypes: 2A, tumor of the MCF; 2B, tumor of the posterior cranial fossa; 2C, tumor of MCF and posterior cranial fossa; 2C type I, MCF <15 mm; and 2C type II, MCF >15 mm.
The extent of MCF exposure through the PPA is 13 mm. Mean suprameatal tubercle dimensions were 10.4 mm × 3.8 mm. Mean extent of bony removal for the PPA was 10.2 mm. PPA was successfully performed in 3 patients without major neurologic sequelae.
Preliminary results obtained with the PPA in 2C type I meningiomas are encouraging. The new classification system proposed can be useful in clinical practice, especially in the choice of the most suitable surgical approach for dumbbell meningiomas.
梅克尔腔（MC）常受肿瘤性病变影响，这些病变通常需要神经外科治疗。我们在新鲜尸体上模拟了岩尖后切除术（PPA），以验证该入路在体内的可行性。我们基于中颅窝（MCF）受累程度提出了一种新的MC脑膜瘤分类系统。
本研究使用了10个新鲜的、未用福尔马林固定的标本。通过乙状窦后入路进行了20次PPA。随后，切除大脑半球以量化MCF暴露情况和颞骨岩部上结节的尺寸。对24例接受MC脑膜瘤手术的患者进行如下分类：第1组，肿瘤<3 cm；第2组，肿瘤>3 cm。第2组再细分为5个亚型：2A，MCF肿瘤；2B，后颅窝肿瘤；2C，MCF和后颅窝肿瘤；2C I型，MCF<15 mm；2C II型，MCF>15 mm。
通过PPA暴露的MCF范围为13 mm。颞骨岩部上结节的平均尺寸为10.4 mm×3.8 mm。PPA的平均骨质切除范围为10.2 mm。3例患者成功进行了PPA，无严重神经后遗症。
2C I型脑膜瘤PPA的初步结果令人鼓舞。提出的新分类系统在临床实践中可能有用，特别是在为哑铃形脑膜瘤选择最合适的手术入路时。
